My French Novel

Every Friday I have my French lesson with my teacher, Claude. For the first half hour we talk in French randomly, but sincerely and intimately, since over the years we have become friends. Then, for the second half hour, I read to Claude a written French text that I have prepared. The setup is this: for each week, Claude gives me a subject — it is always just a word, a noun, but it can be anything — clouds, butterflies, pepper, couch — anything. The rule is I have to include that word in my writing for that week. Other than that, I can write anything. I read what I have written paragraph by paragraph, then Claude reads it back to me and makes the corrections — there are always a lot of them — and we discuss what I meant to say if it’s unclear.

When we started I just wrote a serious essay on whatever the subject was, but I quickly realized that that wasn’t very satisfying. So I thought, why not write a murder mystery, and make every week a new chapter? So that’s what I did, for 60 chapters or so. But then, as the mystery came to an end, and as I realized I didn’t like to plan much in detail, and that I wasn’t very good at plot, I transformed the story to a more modern novel. In fact, it became a post-modern rather existential novel, that I am still working on. As you can see below, I now have around 200 chapters! I skipped some numbers, so maybe it’s really more like 180. But whatever. I have my characters, whom I more or less love, and Claude has her favorites — mostly Juliette, and maybe Jules, I’m not sure. I think I now have about 12 characters, some very constant presences, others more like walk ons. Besides not having much of a plot line, I also discovered that I don’t like my characters to be unhappy, and I don’t like them to fight much, but in their own way, I think my characters are striving toward happiness. Instead of there being difficult problems to be faced, the problems kind of sneak up on them.

As for the post-modern element, I don’t want to give it away quite yet, but let me just say that I become impatient with the fourth wall, and I think that characters ought to be able to speak back to and push back against the author.

So each week as I write another chapter, there are these requirements: I have to include the topic of the week, I have to advance the story, and, importantly, to have to make Claude laugh — every week without fail.

Usually, my chapters are full of dialogue - I think and Claude thinks that this is what I do best. But for some reason, when I wrote a chapter that didn’t have a lot of dialogue, I thought that this chapter - or just half of it, actually, - is something that readers of this blog might like to read best. For some reason I felt touched by it. I won’t describe it more; it’s short, so you can easily read it and decide for yourself.

One other interesting thing is this: my French is improving but I still don’t think in French, and I’m not sure, but I think that as I’m writing, I think in English but then write in French. But then when it’s on the page in French, it just becomes a French chapter, and then when I translate it back into English, it seems a bit stiff and even stilted. Does this mean I actually do think in French? Or more likely, does it mean that translation is hard, and I can’t even do a good job of translating my own writing? I don’t know, it’s a mystery.

So anyway, here is my little extraction of a chapter. First is the French, then my English translation. The word (le sujet) that Claude gave me for this chapter is, obviously, Les Insultes. And you’ll also notice that I have gotten into the habit of sometimes inserting a picture, either one I myself took, or an image from the internet — which is where I got this picture to start off this chapter.

216 Les Insultes - un extrait avec traduction

— Juliette m’a appelé hier, dit Mercedes.

C’était l’automne à Paris, les journées encore ensoleillées, mais le temps plus frais, avec plus de vent, moins de vacances, plus de travail dans les bureaux, et moins de touristes dans les rues et les restaurants. Mercedes aimait beaucoup l’automne, et le changement des saisons en France. Quand elle rendait visites à ses parents à Tunis, d’abord elle aimait la chaleur, mais [] une ou deux semaines après/plus tard elle découvrait que l’air frais du matin lui manquait, et les arbres et les chants des oiseaux parisiens, et puis elle soupirait à son Paris. Maintenant, en automne, elle savait encore mieux qu’elle se sentait chez elle à Paris.

Elle se demandait si c’était sa jeunesse à Tunis qui l’avait poussée à apprécier les saisons en France. Au printemps c’était le temps pour émerger du nid de l’hiver, pour se promener partout dans une veste et un chapeau, et pour prévoir les vacances d’été. Bien sûr, l’été était le temps pour voyager ou pour passer du temps quelque part loin de Paris. Mais l’automne était le temps pour s’installer dans son appartement, pour acheter des nouveaux ustensiles de cuisine et des vêtements pour l’hiver. Et cette année, uniquement pour elle, c’était la saison pour commencer sa vie en tant que l’unique femme dans la vie de Jules. Pour Jules, de son côté, il est possible qu’il ait acheté sa bague sur un coup de tête. Mais dans l’esprit de Mercedes, bien qu’elle reconnaissait cette possibilité, ça [] signifiait la même que pour tout le monde — cette femme et prise ! Et elle pensait à se conduire de manière appropriée pour une femme avec une bague.

— Oui ? dit Jules.

Jules, bien sûr, avait un peu remarqué quelque chose de nouveau. Avec son histoire de mariage, il n’avait pas pu être conscient d’un tel changement. Mais, c’était sans aucun doute qu’il avait un nouveau sens de la stabilité, cependant clairement il s’en méfiait. Ce n’est pas sa coutume d’être confortable dans sa vie. Il aimait bien que Mercedes soit toujours là, mais il se méfiait de ça aussi. Il se demandait pourquoi elle ne faisait pas de voyages [] on ne savait pas où, en disant comme avant, << à tout à l’heure, je reviens dans une semaine >>. Elle n’avait pas même dîné avec ses amies. << C’est un peu bizarre,>> il se dit, mais il trouvait que c’était très agréable d’être avec elle toutes les nuits, et pendant que les crépuscules commençaient [] de plus en plus tôt, Jules se trouvait de plus en plus détendu. Quand il réfléchissait à ça, il avait [] tendance à devenir un peu méfiant, mais il ne pouvait pas résister à la femme douce et à ses yeux bruns foncés et ses embrasses. Une fois, il suggéra même qu’ils fassent des achats ensemble pour une lampe pour le fauteuil qu’elle préférait. Mercedes l’avait bien remarqué, mais sagement, elle n’avait rien dit

Il trouvait même qu’ils pouvaient cuisiner ensemble, ce qu’il n’avait jamais fait avant avec personne. Il trouvait même qu’il ne restait pas au bureau comme avant ; en revanche, il s’assurait l’après-midi qu’il pourrait partir à l’heure afin de rentrer à l’heure.

À l’heure. Il n’avait jamais été à l’heure de toute sa vie ! Il avait été allergique à << à l’heure. >> À l’heure était un thème de sa mère. Sa phrase insulte avait été ça << il n’est jamais à l’heure ! Quel garçon bête - il ne peut pas interpréter une montre ! >> Ses [] trois ex-femmes s’étaient plaintes de la même chose. Car, c’était une surprise pour lui-même d’être habituellement à l’heure maintenant, et il était surpris aussi par son nouveau sens de calme. Il se demandait pourquoi il n’était pas [] à l’heure auparavant, mais il ne pouvait pas décider pourquoi. Et la plus grande ironie était maintenant, qu’il n’y avait pas une heure déterminée de rentrer ! Mercedes savait qu’il n’aimait pas [] avoir une heure fixe de rentrer, alors elle s’assurait qu’elle avait plein de chose à faire à la fin de la journée dans l’appartement pour pouvoir patienter. Mais, quelle surprise, comme un chien prêt à dîner, tous les soir à six heures, il était là. Elle finit par l’appeler << mon chiot. >>

En bref, pauvre homme, il ne reconnaissait pas qu’il avait enfin trouvé son amour. Il ne reconnaissait pas que sa vie chez eux avait remplacé sa vie au bureau en tant que vie principale. Il ne comprenait pas que sa vie d’auparavant avait disparu, et que c’était une bonne chose. Il devait s’habituer au fait qu’il était devenu Dorothy, et que sa vie avait changé du noir et blanc au technicolor dans un nouveau monde, sans [] chaussures rouges.

En anglais:

“Juliette called me yesterday,” said Mercedes.

It was autumn in Paris, the days still sunny, but the weather fresher, with more wind, less vacation, more office work, and fewer tourists in the streets and the restaurants. Mercedes loved autumn, and the changes of the seasons in France. When she visited her parents in Tunis, at first she liked the heat, but after one or two weeks she found that she missed the morning’s fresh air, and the Parisian trees and the songs of the birds, and then she longed for Paris. Now, in autumn, she realized even more that she felt at home in Paris.

She wondered if it was her youth in Tunis that had led her to appreciate the seasons in France. In spring it was time to emerge from the nest of winter, to walk everywhere in a jacket and a hat, and to plan the summer vacations. Of course, summer was the time to travel, or to spend time somewhere away from Paris. But autumn was the time to settle down in your apartment, to buy some new kitchen utensils and some clothes for the winter. This year, uniquely for her, it was the season to start her life as the only woman in Jules’ life. As for Jules, it’s possible that he had bought her ring on an impulse. But to her mind, even though she recognized that possibility, the ring signified for her what it signifies for everybody — this woman is taken! And she intended to conduct herself in a manner appropriate for a woman with a ring.

“Yes?” said Jules.

Jules, of course, had hardly noticed something new. With his marital history, he couldn’t register such a change consciously. But, there was no doubt that he had a new sense of stability, however suspiciously he looked at it. It was not his usual experience to be comfortable in his life. He liked it a lot that Mercedes was always there, but he viewed it with suspicion nonetheless. He wondered why she wasn’t taking trips to some place she didn’t tell him about, saying as she used to, “See you soon, I’ll be back in a week.” She hadn’t even eaten out with friends. “It’s a little weird,” he told himself, but he found that he liked being with her every night, and while dusk started to come earlier and earlier, Jules found himself more and more relaxed. When he thought about that, he would become a little suspicious, but he could resist the sweet woman, and her dark brown eyes and her kisses. Once, he even suggested that they shop together for a lamp for her favorite chair. Mercedes had certainly noticed that, but wisely, she hadn’t said anything.

He even found that they could cook together, which he had never done before with anyone. He even found that he didn’t stay at the office as he used to; instead, he made sure in the afternoon that he would be able to leave on time so he could be home on time.

“On time.” He had never been “on time” in his whole life! He had been allergic to “on time.” “On time” was a theme of his mother. Her expression of insult had been this: “He is never on time! What a stupid boy - he can’t read a watch!” His three ex-wives had complained of the same thing. So, it was a surprise to himself that he was now always on time, and at the same time he was surprised at his new sense of calmness. He wondered why he didn’t used to be “on time,” but he couldn’t figure out why. And the biggest irony was now that he didn’t have a specific time to be home! Mercedes knew that he didn’t like to have a deadline to be home, so she made sure that she had plenty of things to do at the end of the day in the apartment so that she could wait patiently. But, what a surprise, like a dog ready for dinner, every night at six, there he was. She wound up calling him “my puppy.”

In short, poor man, he didn’t recognize the he had finally found his love. He didn’t realize that their life together at their place had replaced his life in the office as his main life. He didn’t realize that his previous life had disappeared, and that that was a good thing. Now he had to get used to the fact that he had become Dorothy, and that his life had changed from black and white to technicolor in a new new world, minus the red shoes.

 

Budd Shenkin

The Celebration of Life for Ann Morrisroe Shenkin, March 26, 2022

Our Celebration of Life for my wife Ann was held at the Claremont Spa and Resort -- our neighborhood hotel and meeting place here in south Berkeley, with some 90 friends and family in attendance, and more on Zoom.  It was a lovely and memorable affair.  As we all said, if only she could have been there to see it, she would have been amazed, and I think overwhelmed.

I spoke, her three kids Sara, Brian, and Peter spoke, her son-in-law Eric spoke, her brother Paul spoke, her brother-in-law Bob spoke, two of the kids' friends who were particularly close to us spoke, a neighbor spoke, Sara's sister in law spoke from Chambéry in France, and we then adjourned for a lunch that Ann would have loved -- burgers, fries, Caesar salad, and brownies for dessert.

The eulogies are recorded here in an hour long Zoom recording, which includes some slides:

https://drive.google.com/file/d/1kxucgXuiflGV1JDOkbe3taflmM_0tL4m/view

And here is the text for my Eulogy:

Ann’s Eulogy

March 26, 2022

Introduction

Thanks for being here today.  It’s a great turnout, and I think that’s a tribute to a very remarkable person.  Here at the start, I want to echo Peter in acknowledging Sara Buckelew, First and only Daughter, who did the major part of arranging this whole affair.  It is completely in character for Sara to pop up when help is needed, particularly in support of her mother.

Ann had 76 years.  I tried to set myself the task of summarizing those 76 years here, while respecting her constant advice to me every time I got up to speak — she would whisper to me, “Be Brief!”

Well, of course, that can’t be done.  So I’m going to try to hit her highlights — eulogy means “praise,” in Greek, so I’m going to try to encapsulate the triumphs of her life in 15 or 20 minutes.  And I’ve written it all down, so what I’ll miss in spontaneity, I hope to make up for in compactness.

Anyone who knew Ann recognized her great grace, class, intelligence, and wit.  What you might not know about is how brave she was.  She was so very brave.  So, what I want to try to do, is to look at her life as it would be portrayed as a TV serial, Season One to Season Six.  At each point, let’s be sure to look for her bravery.

I also can't resist sharing with you what my brother Bob, a judge in Pennsylvania – who loved Ann so much – what he said when I was receiving a award from the Academy of Pediatrics and I was being praised.  He said to me, as only a brother could, “This is nice, but when is it time for rebuttal?”  Today, as then, there will be no rebuttals.


Season One - Early history – the Morrisroe family, through high school

Ann’s father, John Morrisroe, was a remarkable man.  He grew up in a working class gloriously Irish family that moved all over America.  They finally wound up in Hell’s Kitchen in New York City.  John's granddaughter Sarah Morrisroe Mester, who is here with us today, wrote about his life when she was a high school senior.  She said his story was the story of American opportunity, and so it was.

Whip smart, John won a Pulitzer Newsboy's scholarship to Columbia – from Hell's Kitchen to Columbia! - and became a chemical engineer.  He married Barbara Lane of Long Island, they moved to California, and Ann, the second of their 5 children, was born here at Alta Bates Hospital.  Then they moved to San Marino in Southern California, where Ann grew up, and where John founded his own highly successful company, Pilot Chemical.  Ann’s beloved brother and sister, Paul and Nancy, are with us here today.

Paul described the child-rearing philosophy of their mother as, “children should raise themselves.”  As Nancy says, though, she did have the ideas of a woman’s place that was typical for her generation.  Her main ambition for her daughters was that they get married.  She might not have been ready for how smart  Ann was, like her father, and how strong willed, also like her father.  Ann would have to forge her path on her own.

Ann was unhappy at San Marino High because, her guidance counselor said, she was the smartest girl in her class.  But her smarts didn't stop her from being a Southern California girl.  She roasted with her friends in the sun, and at the age of 16, she got a Pontiac Firebird.  From that time forward, Ann always had cars with style.  I wish I had a picture of her with her Firebird.

Also of note is an early athletic triumph — as a swimmer, Ann turned out to be a champion floater!  Now, that’s a distinction she was always quietly proud of, especially in our sports-enthusiastic family.

Season Two - Off to college, marriage and children

So let’s go to Season Two, when Ann headed for Cal with a suitcase and an address, never to leave Berkeley as her home, although she didn’t know it, of course.  Ann loved Cal!  Class of 1967, so many friends — including Mike Emery, here with us today — the excitement of Free Speech, she loved being an English major.  Basically, she had a hell of a time in college.  Then when she graduated she stayed in the East Bay and got an assistant editor’s job at Harcourt Brace in the City.  And then, much to her mother’s relief, I suppose, she found a lovely husband, Bruce Buckelew.  Bruce and his wife Kate are here today.  Bruce’s philosophy contrasted nicely with Ann’s realism,  Bruce has always looked for the best in people, while Ann has taken the Irish view of the perpetual iniquity of mankind.  

They were a lovely couple.  They had two wonderful, healthy, intelligent, lively children, first Sara and then Brian, Bruce had a job with IBM, and Ann stayed home with the kids.

These years were particularly significant for Ann because of her determination that her kids would be raised with more parental guidance than she had gotten.  She and Bruce were great parents to Sara and Brian, and as a pediatrician, I have to say that their later success - Sara is a full professor of pediatrics at UCSF and Brian is a newly appointed judge in Santa Clara county — can be at least partly traced back to that important early childhood confidence building.


Season Three – Disruption, falling in love. Back to work, blend the families, then to law school, and legal career, Avenue Books, and baby Peter.

In season three, things got complicated.  The 70's was hard on marriages.  Ann's marriage collapsed almost simultaneously with the marriages of her two best friends.  Then she and I fell helplessly in love.  And from then on, our personal stories for the next 44 years were the story of the two of us.

When we got married we each had joint custody of our kids, her two — Sara and Brian —and my two — Allie and Nick — and we tried to blend our families.  Our kids got on very well with each other, even loved each other, chose to be with us at the same time rather than separately, called each other brothers and sister.

To look ahead, throughout our marriage to the very end, our feelings never stopped being intense, even when, inevitably, things got rough.  Ann's feelings might have resembled those of the New York lady who was asked, after a long marriage with a difficult man, if she had ever considered divorce.  She answered – “Divorce?  Never!  But murder....”  

So in 1977, Ann stopped being a housewife and joined the world at work.  She was assistant to the Chancellor at UCSF Medical School, and as soon as her employers saw what they had lucked into with her, they put her in charge of charming Joseph Long, who wanted to give millions for what would become Long Hospital.  She helped them get those millions.  She had class, she was so pretty and charming, and she was so smart.  

Then she wanted more and went to law school at USF, where she excelled, was asked to join law review, and then passed the bar in her first try.  She practiced family law in the East Bay for 7 years, trying to bring out the best in people, just when they were usually at their worst.  Then, like so many others in that tiring pursuit of family law, she made another very brave decision – she quit law to join Brian Rood, who is here today, at Avenue Books on College Avenue.  She found it much more peaceful living among books and the people who loved them.  We loved Avenue Books.

During this time, finding that 4 kids were not enough, Ann and I decided to have another, and we were blessed - and I mean blessed — with Peter.  He was 5 weeks premature because Ann developed a rare condition called HELPP Syndrome.  Both were sick in the hospital at Summit, but both pulled through.

It’s funny how the last addition can be someone you can't imagine the world without.  What a keystone to our family, what a great kid, what a sports fan!  As the baby in the family, Peter was the focus of love from the other six of us, and always will be.  I won’t embarrass him further by singing his praises, but let’s just say, every time I would say “Peter Shenkin” to Ann, she would just smile and shake her head in disbelief.

Here’s a picture of Ann with Peter at UCSF hospital after Peter had his heart surgery to close an ASD.  


Season Four — 80’s and 90’s

Season Four was the 80’s and the 90’s, all of us working hard, all the school and sports activities, vacations, burgers and fries, great Christmas dinners, and Ann learned to make great latkas.  All those ball games!  Even though she was not religious, she had a special prayer, called Ann's Prayer, uttered before going into the stadium before every baseball game, “Please, God, no extra innings!”

She supported me at work.  When I told her about a difficult case, she would say, “Did you get a consultation?”  She tried to protect me.

She loved to travel, and this is when we started.  It's amazing what staying in the same house that was bought in 1972 and having a mortgage of $289 a month can do for you.  Where do you want to go, she'd ask me?  I would murmur a vague wish.  She made it come true.  

Ann always tried to give thoughtful gifts.  One year she surprised me at Christmas with a present of tickets to the final Four in Atlanta.   For that feat, she was voted mother of the year by Peter's friends.


Season Five -- Against The Odds

To accomplish what she did — being the first woman in her family to go to college, to be so successful at UCSF, to go to law school, to form her own independent political opinions and defend them — Ann had to be tough and resilient.  At about this time, she realized she had another obstacle to surmount.  

She realized that she had to stop drinking.  So she did.  She worked hard, and she succeeded, where so many others have failed.  She never took another drink.  That's not easy.
 
Her decision and her resolution gave her and our family 20 years of life that we wouldn’t otherwise have had.  We were and are so proud and so grateful.  She was my hero once again.


Season Six – Years of Stability and Growth and Life Enhancement

The years of 2000 to 2014  started with a trauma — Peter got hit by a falling tree as his class camped by the American River, and Peter escaped by the skin of his teeth.   The whole family, and much of the school, gathered at his bedside at Sutter Hospital in Roseville.  Ann was shaken, but steadfast.  Her little boy.  But once again, we all had so much to be grateful for.  It was really a matter of inches.  

Then, as Peter recovered and was the last kid to fly away from the nest, we had years of great growth for us.  We started those years by buying a condo in Maui and then building a house there.  Ann had always wanted to design her own house, and she did a magnificent job.  What taste!

No marriage is completely smooth, and ours was rockier than most.  They say that arguing is normal in marriage and is a sign of love.  My wife loved me very much.  We saw a marriage counselor to help us over a particularly rough spot.  We found it so useful that we figured, even when things were going very well, why should we stop?  So we didn’t.  In fact, our therapist became so fond us that he moved his office from around the lake to just down from here on Ashby, walking distance.  We were so grateful.  But seriously, we never stopped wanting to be better persons and have a better marriage.  I guess you could say that we were achievers.

In 2012, I got a chance to retire – Stanford wanted to establish a network of pediatric offices, and our practice, Bayside Medical Group, was the top target on their list.  This was a chance for us, because I could retire leaving the practice in strong hands for our patients, our clinicians, and our staff.  When I got the offer and was driving up Sand Hill Road, I called her to tell her that the deal looked acceptable.  What she told me was pure Ann.  She gave me the wifely advice and support I had come to cherish. She simply said, “Now, don't fuck it up!”  Ahhh, my wife Ann.
Season Seven – retirement and then a new illness

So we retired.  We traveled, we relaxed, we got used to my being home more.  And then Ann had trouble writing, and when we followed that up, we got the diagnosis of Alzheimer's.  Alzheimer's took away one function after another, but she never lost her mind.  She was always Ann.  Always the woman I loved.  

We decided to make the most of the years we had.  We took the trips that Ann loved.  We had always traveled, so now we did it even more.  

Here are some of our travel slides, from the earlier years to the later ones.  I have a captive audience here — I think I’ll subject you to our travel slides !  Why not?  No, not really.  But I am going to flash some slides to show you how great she looked and how happy she was when we traveled. 

Alzheimer’s is devastating, but for us, it was also slow, until the end.  As she would lose some functions, we would find ways around them, I would fill in the gaps so that she would be as happy and as comfortable as possible.  I would take care of my little girl.  

Then, as time went on and she had trouble going out, we were lucky to find wonderful medical support in our doctors, the hospice program, and finally our wonderful health aides.

And as I said, Ann was always so brave.  She did not complain, she just went on as best she could.  I admire that so much.  

We were so lucky.  Everyone who has ever cared for us, from Alice who took care of the house and helped raise Peter and called him “my white son,” to José and Antonia who have worked at the house and garden for 25 years, to our health aides, they all loved Ann.  Really, they saw her for the kind and lovely person she was.  Alice said that Ann was her best friend, José and Antonia call her “a wonderful woman,” and Lai and Carol and Wilma, her health aides in her last year, all loved and respected her.  A week before she died, when she could hardly speak, she turned to Carol and said, three times: “Thank you, thank you, thank you.”  Carol knew she was saying goodbye.  And she told Lai, “I really like you.”  Here she was in her last days, and she could hardly talk, but she thanked her aides.  That tells you a lot about a woman.

When she could finally go on no more, she was in her hospital bed in our room in our house on Oakvale, where she had lived since 1972, and the three kids and I were all at her side.
 

Summation

Ann’s life was a life rich with fulfillment.  It was a battle, with wins and losses.  She was a great mother to her kids.  She was loved by them and many others, she did most of the things she had dreamed of doing, and she was a very good and principled person.   

I love and admire her so much.  She was elegant, she was intelligent, she was charming, she was responsible, she was gorgeous, and she was kind.  We are grateful that Ann is released from her struggles, but we are all heartbroken.  But we are also all so proud of her.  When she got sick, there was never a complaint, only bravely going on.  She is the bravest person I've ever known, I think.  

I think she was wonderful.  But then, when it comes to Ann, my little girl, I'm the most prejudiced person in the world.


And now, some final slides to show you how beautiful Ann was.  (See recording.)

Budd Shenkin

A Tragic Case, And No Apparent Medical Fiduciary To Assist A Patient

 

The San Francisco Chronicle just ran an article today. A two year old little girl was found with liver cancer that had metastasized to the lungs. She was treated initially with chemotherapy and then needed a large resection of part of her liver. Resecting a part of a liver in a two year old is an uncommon and dangerous procedure, almost always performed in a very specialized children's hospital. In this case she was operated on at John Muir Medical Center (JMMC), located in the East Bay suburb, Walnut Creek. She died on the operative table.

This is a scandal. The Chronicle devoted about six full pages to it. What did she die of? An air embolus, over-transfusion and other mistakes by the anesthesiologists, a nick on the vena cava by the operating surgeon? The lawyers will want to know, but whatever it was, that was only the proximate cause of the death. The underlying issue is this – this happened in the heart of the Bay Area, not some rural area with few resources. How did it happen that with all these top, experienced resources available, the child was treated at JMMC, which, although it has aspirations to be so, does not yet belong among those elite institutions? With all the experience and practiced teams in these other institutions, how did this little girl wind up being at an institution where she was their very first patient to receive this operation? Whatever the reason was that she wound up at JMMC, that was the cause of her death.

I myself had a serious condition 10 years ago, a tumor the size of a small tomato in my pituitary gland in the middle of my head. It's not as rare and and not as dangerous as this little girl's liver cancer, but it isn't beanbag, either. But unlike the little girl's family, I am a medical insider. I'm a doctor who practiced for over 30 years in this area, so when I got my diagnosis, I knew my way around. I found my way to a surgeon whose specialty was just the condition I had, and instead of being the first operation that he performed for my condition, I was number over 2,000, and the hospital where he operated on my had been the site of hundreds of these operations. That's what you want for your condition. You don't want to be a pathbreaker if you can help it; you want to be “another one of these.” The little girl could have been that, but she wasn't. She was a pathbreaker needlessly.

Who directed her to JMMC? They say in the article that they were reassured that the doctors were from Stanford, and that the site was nearer to them, even though they could have gone down to Stanford's home hospital in less than an hour. They were assured that JMMC was excellent; the doctors were confident, JMMC is on the glitzy side, upscale. But what you can be assured they were not told was that this was JMMC's first pediatric liver resection.

So what I'm thinking is this: at some point their primary care pediatrician must have been involved. Was it he or she who directed them to JMMC? Or, did the family and the pediatrician contact Stanford and Stanford directed them to JMMC, their affiliate they were eager to get off the ground? Who did it? Why did they do it? Were they aware that they were putting the interests of the hospital above those of the patient's?

One of the main jobs of a primary care doctor should be to be a health care fiduciary for their patients. The meaning of this term is analogous to the financial industry. When you have a financial advisor that person needs to look out for your financial well-being and not just recommend the in-house mutual funds, which might be higher priced and lower performing than other choices available in the market. A primary care doctor needs to do the same for his or her patient – find the best and most appropriate.

So, one of the things I would want to know is, who is the primary care pediatrician for this patient, and what was his or her contribution to the JMMC referral? In particular, was that pediatrician associated with JMMC? How closely was the primary pediatrician involved in picking the specialist referral?

It's not just primary doctors who can serve the patient as a fiduciary. My friends Bob and Adele Levin have written an important book, I Will Keep You Alive, that highlights the brave fiduciary role played by Bob's cardiologist in steering him away from an overly activist cardiac surgeon at her home hospital in favor of a more nuanced surgeon across the Bay.

Others are obviously culpable as well. The Chron article details how a brave internal experienced physician warned strongly that this operation was beyond the hospital's capability, and for her efforts her contract was not renewed. The hospital and top staff continue to insist that their decision was not a bad one. A doctor friend of mind thinks that Stanford should be on the list of parties being sued, since they had a hand in allowing this to happen.

Myself, I think the health fiduciary role of the primary care physician is grossly underestimated. The role is not taught at our institutions, and it is underestimated as hospitals increasingly buy practices and form their own networks.

I've made this point before.

The issue can actually be rather subtle. The best primary care doctors want to act as the patient's medical fiduciary, looking out for the patient's best interest in every way, beholden only to the patient, not to the company who employs him or her, or to the payer. Sometimes, that means finding the best person and facility for the patient with every condition and for every test. Networks, based on who signs up for whatever reason, and those who don't sign up for whatever reason, constrains the ethical duty of the health fiduciary. What can be done to enable the doctor to refer the patient for the patient's best interest, despite network relationships? Something should be done.

Budd Shenkin

Time's A-wastin'! A Poem.

 Time's A-wastin'

Time is very relative.

I was 26 just last week,

I'm pretty sure.

The road ahead looks long

Who knows when it will end?

No time soon,

I'm pretty sure.

All my lab studies are so normal.

Right now is awfully alive.

I have so many things to do.

I wonder if I can do them all.

If I have enough time, I can,

I'm pretty sure.

I'd better get going and do some of it every day,

Because time is short,

I'm pretty sure.

Berkeley Goes To The Mat On Housing

 

Berkeley is a university town – well, it's a city, although it used to be a town. But we have neighborhoods, and although everyone is proud of and pretty much supports Cal, as the University of California at Berkeley is known, there are the usual town/gown pressures. It can be financial, since all that land is untaxed. There are arrangements that Cal pays the city some sizable fees, but the university still comes out on top. And their missions must inevitably conflict – the University is an organization, and organizations want to grow. But the city has to absorb the people who are part of the growth, and it can be hard. The University houses only 23% of its students, and the rest have to find housing locally. If there are more and more, and more and more, and more and more students, there has to be more and more housing. I forget the details, but the essence of it is that the university makes promises of producing commensurate housing as it grows, and then breaks them. They are arrogant. They are self-important. They really do pretty much what they want to do. What's new with university administrations?

The city resists, usually. Weakly, but it resists. It tries to get better deals, but in the end the city generally folds, and tries to increase its budget by taxing the residents. They say the new taxes are for something great, but the fine print shows that the money will just go into the general fund. They do what cities do, they use slight of hand and hope not to be seen doing what they're doing. They are arrogant. They are self-important. The city is composed of an elected City Council whose members often have an agenda based on their ideology and the views of the district they represent, and permanent city officials are do what permanent city officials do. They come to work and they do everything they can not to be fired. They keep their heads down. They are not top quartile graduates.

Berkeley is full of people who know how to be activists, so there are neighborhood organizations that represent the neighborhoods, even while the elected city council representatives, who are elected by district, are supposed to do the same. The neighborhood organizations are all volunteer, with no paid staff. Like all organizations, they have leaders who generally get their way, but it's significant that the city permanent government, the elected representatives on the city council, and the unelected volunteer neighborhood organizations frequently have quite different views on issues.

Anyway, the University wants to expand and doesn't really care how the city handles the extra students. Because of the growth of students and the lack of significant growth of housing, there has been an increasing number of students who are homeless, and who are on food stamps. It's hard to get the University's attention to this, but it's true. The city government has been like other city governments in being slow to approve new housing in the city, and the neighborhoods have been reluctant to see the character of where they live change. If you live on a pretty tree-lined street with houses, you are understandably reluctant to see houses turned into four-plexes, to see apartment houses appear, to find trees on lots disappear, to find parking become more difficult, and to find your pleasant neighborly street, where everybody knows your name, turn into New York City.

So, deadlock. Until now. There has been a turnover in the City Council, and they have swung to the side that says we have a national problem of not enough housing, we all have to learn to live with higher density, it will be patriotic to do so, try it you'll like and even if you don't, tough nuggies, you'll have to live with it. The University Department of City and Regional Planning has lobbied hard that this is what the country needs, and most importantly, it's the progressive thing to do. They have made the argument that single family home zoning is racist, and it is anti-student and thus anti-education.

The City Council has echoed this view. Our local council member says in her latest newsletter: “Not only do our academically motivated kids have to weather a pandemic, but they now have to deal with the potential of having their educational dreams crushed.” She has made the argument previously that when single family home zoning was adopted 100 years ago, it was with the intention of keep out people of color. She also says, “I don’t say this lightly—I fundamentally believe this is a civil rights issue. This is about fair access to education and equity, particularly for lower income families and communities of color who will be most impacted the most by this ruling.” The ruling she refers to is the freeze on enrollment increase at Cal imposed by the California Supreme Court.

Nobody says it, but there is a good deal of resentment against people who can afford to live in single family homes. Some of these residents are well-paid, and others have simply lived there for decades, starting from before there was such housing inflation. Berkeley has always harbored a good deal of the politics of resentment. Abolishing zoning for single family homes would seem to be a way to get back at those who live there. The San Francisco Chronicle has covered it here.

I remember about 30 years ago when they abolished our neighborhood elementary school, which was fully integrated, because it was too good. They didn't want one school outperforming others because it wasn't fair. In private conversations, the school board admitted that. They turned our local school into a magnet school. Equality tasted better than quality.

So, naturally, when our council member made her case in the newsletter, I rebutted. Here is my over-the-top letter:

Dear Lori:

As your constituent, I would like to weigh in on the UCB expansion issue, as well as the dropping of zoning for single family houses.  I have lived in Berkeley since 1974, am a graduate and supporter of the Goldman School of Public Policy, and I currently sit on the Board of Advisors for the Goldman School.  My wife graduated from Cal, and her daughter graduated from the School of Public Health.  We are a Cal family.

I would like to see the Goldman School get its expansion.  But that is quite apart from the relentless expansion of Cal. I have seen up close how they have expanded without fulfilling their responsibilities to provide housing, and how the students have suffered, including living in cars and relying on food stamps.  This is the direct result of irresponsible expansion.  Now the situation that they consciously created is laid at the feet of the neighborhoods, and the agreed upon solution appears to be to change the population density of all of Berkeley.  Not to do so is called depriving students of a decent education.  It is even called racist - you personally have made this argument - because zoning a century ago had racial prejudice as one of its objectives.  To apply this motivation to the current situation is ludicrous, incendiary, an unfair. To want to live in a traditional neighborhood is not equivalent to wanting to exclude people of color. This should be obvious.

Now, even with these sins of unsupported university expansion in their past, which the university seeks to bury, the university promises to "limit" its expansion to "only" 1% a year.  A quick calculation tells us that this means 10% larger in 10 years.  The way to supply the housing infrastructure for this constant expansion?  Let's let the students pile into the neighborhoods - double up, you guys!  Sell your houses to developers, who will convert your houses into condos, demolish them to increase population density double or triply or even more, allowing developers and others to make a mint in the process, and changing the nature of Berkeley irrevocably.  The nature of Berkeley is to be apartments, condos, and personal congestion everywhere, because not to allow high-density housing everywhere would be anti-education, and more than that, "racist." What an agenda! What specious argumentation! What attempts to intimidate!

I would like to see the Goldman School get its expansion.  Since their plan includes housing, it should be rather simple to justify. I would like to see more deserving students served.  But there are other ways to expand without turning Berkeley into a replica of the area surrounding Columbia or NYU.  When Harvard needed to expand, they went to Allston, just across the Charles River, and did it there.  Cal could do something similar.  They can and should plan for a new campus, where room for housing is available. There is no need to make Berkeley an example of how to fit more and more sardines in a can.

Frankly, I am appalled at the stance taken by our city government, which is carrying Cal's water.  The highly ideological and inflated rhetoric, full of specious reasoning and implying craven motives to those who simply want to see pleasant neighborhoods preserved, especially the accusations or innuendos of racism, are beyond the bounds of reason and comity, pollute the waters of fair and reasoned discussion, and are unfair to the neighborhood citizens who better represent the community of Berkeley than does our government.

I'd like to see you do better.

Budd Shenkin

Take that!

Budd Shenkin